Outcomes from 871,441 Consecutive Surgical Procedures Without Overlap or with Maximally Permissible Nonconcurrent Overlap.

Abstract

To isolate the impact of subsumed surgery (a shorter procedure completed entirely during overlapping noncritical portions of a longer antecedent procedure) on patient outcomes. The American College of Surgeons recently recommended the elimination of "concurrent surgery" with overlap during a procedure's critical portions. Guidelines for nonconcurrent overlap have been established, but the safety of subsumed surgery remains to be examined. All consecutive procedures from 2013 to 2021 within a multihospital academic medical center were included (n=871,441). Simple logistic regression was performed to compare postoperative events between patients undergoing non-overlaping surgery (n=533,032) and completely subsumed surgery (n=11,319). Thereafter, coarsened exact matching was used to match patients with non-overlaping and subsumed surgery 1:1 on CPT code, 18 demographic features, baseline health characteristics, and procedural variables (n=7,146). Exact-matched cases were subsequently limited to pairs performed by the same surgeon (n=5,028). Primary outcomes included 30-day readmission, ED visits, and reoperations. Univariate analysis suggested that subsumed surgery had a higher 30-day risk of readmission (OR 1.55, P <0.0001), ED evaluation (OR 1.19, P <0.0001), and reoperation (OR 1.98, P <0.0001). When comparison was limited to the exact same procedure and patients were matched on demographics and health characteristics, there were no outcome differences between patients with subsumed surgery and non-overlapping surgery, even when limiting analyses to the same surgeon. Similar surgeries for similar patients result in similar outcomes whether they are performed completely subsumed or without overlap. Individual surgeons performing a specific procedure have no outcome differences with subsumed and non-overlapping cases.